Full Endoscopic Translaminar Keyhole Diskectomy for Highly Upmigrated Lumbar Disk Herniation

Case: A 49-year-old man underwent full endoscopic translaminar keyhole diskectomy for highly upmigrated disk herniation at L5-S1. This scope-in-scope technique involved creation of a targeted fenestration in the lamina using a large working cannula (13.7 mm) and endoscope (10 mm). This was followed by advancement of a smaller working cannula (7.5 mm) and endoscope (6.3 mm) into the fenestration to remove the upmigrated disk fragment. Surgery resulted in excellent outcomes. Conclusion: This can be a safe and effective surgical option for highly upmigrated disk herniation. It limits the amount of bone removal by directly targeting the herniated fragment and reduces the chances of neural injury.